1366540965 NPI number — MS. SUDI PLACE SCULL MA

Table of content: MS. SUDI PLACE SCULL MA (NPI 1366540965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366540965 NPI number — MS. SUDI PLACE SCULL MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCULL
Provider First Name:
SUDI
Provider Middle Name:
PLACE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCULL
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
PLACE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366540965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
78 PERALTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-282-8185
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2166 HAYES ST
Provider Second Line Business Practice Location Address:
# 308
Provider Business Practice Location Address City Name:
SF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-282-8185
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT36910 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)